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Placebo improves pleasure and pain through opposite modulation of sensory processing

Journal article
Authors Dan-Mikael Ellingsen
Johan Wessberg
M. Eikemo
Jaquette Liljencrantz
T. Endestad
Håkan Olausson
Siri Leknes
Published in Proceedings of the National Academy of Sciences of the United States of America
Volume 110
Issue 44
Pages 17993-17998
ISSN 0027-8424
Publication year 2013
Published at Institute of Neuroscience and Physiology, Department of Physiology
Pages 17993-17998
Language en
Links dx.doi.org/10.1073/pnas.1305050110
Keywords expectancy, neuroimaging, hedonic feelings, INDIVIDUAL-DIFFERENCES, INDUCED EXPECTATIONS, OPIOID ACTIVITY, BRAIN, IMAGES, SOCIAL TOUCH, ANALGESIA, PLEASANT, RELIEF, CORTEX, REWARD
Subject categories Neurosciences

Abstract

Placebo analgesia is often conceptualized as a reward mechanism. However, by targeting only negative experiences, such as pain, placebo research may tell only half the story. We compared placebo improvement of painful touch (analgesia) with placebo improvement of pleasant touch (hyperhedonia) using functional MRI and a crossover design. Somatosensory processing was decreased during placebo analgesia and increased during placebo hyperhedonia. Both placebo responses were associated with similar patterns of activation increase in circuitry involved in emotion appraisal, including the pregenual anterior cingulate, medial orbitofrontal cortex, amygdala, accumbens, and midbrain structures. Importantly, placebo-induced coupling between the ventromedial prefrontal cortex and periaqueductal gray correlated with somatosensory decreases to painful touch and somatosensory increases to pleasant touch. These findings suggest that placebo analgesia and hyperhedonia are mediated by activation of shared emotion appraisal neurocircuitry, which down-or upregulates early sensory processing, depending on whether the expectation is reduced pain or increased pleasure.

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